Stricter monitoring needed for minor tranquillisers, expert warns

Prescription tranquillisers such as Diazepam are commonly prescribed for anxiety and insomnia.

By WADE ZAGLAS

A medical expert is calling for a range of commonly prescribed minor tranquillisers to be monitored as strictly as highly addictive painkillers through the use of “real-time” monitoring systems.

Victoria and Western Australia are next year expected to roll out real-time monitoring of Schedule 8 drug prescriptions – which covers highly addictive strong painkillers, such as Oxycodone – and one benzodiazepine, alprazolam (Xanax).

However, experts have raised concerns that harmful and addictive Schedule 4 drugs – which include benzodiazepines such as Diazepam (Valium, Antennex), Temazepam (Temaze and Normison) and Nitrazepam (Alodorm and Mogadon) – are being overlooked.

According to the Royal College of General Practitioners, “every year in Australia nearly seven million prescriptions for benzodiazepines are issued, with Valium and Temazepam among the most common”.

Addiction medicine specialist Dr Philip Wu from Mandurah Medical Centre in Western Australia said S4 benzodiazepines were highly addictive and potentially even more dangerous than strong painkillers, since patients taking them could die either from an overdose or by rapid withdrawal from the drug.

“Benzos as a class are very addictive. We should be prescribing fewer benzos. Even those (patients) who are controlled and monitored are still taking highly addictive medicine,” Dr Wu said.

Although benzodiazepines can play an important role in emergency settings, a 2014 study found an association between their use and an increased risk of dementia, suicide and depression.

Benzodiazepine overdoses (see table below) have risen steadily in recent years, especially in relation to Diazepam, an S4 medication prescribed primarily for anxiety. In six years the overdose deaths from that medication nearly doubled, from 104 in 2009 to 192 in 2015

To counter this problem, Dr Wu has joined a chorus of other medical professionals who are calling for real-time monitoring of all drug prescriptions through “real-time monitoring systems”, such as the Commonwealth Government’s Electronic Recording and Reporting of Controlled Drugs system (ERRCD). The system provides an up-to-the-minute record of the patient’s prescribing history.

Medical experts argue that real-time monitoring is the only way to fight the problems of doctor shopping, addiction and overdose. Doctor shopping occurs when a patient visits multiple doctors to obtain substantial amounts of a particular medicine, usually of an addictive quality.

At present, there is a doctor shopping hotline GPs can use to check their patients’ prescribing history, yet, as a recent episode of Lateline revealed, too often doctors rely on their professional judgement to determine if patients could be addicts.

Also, the hotline does not identify private prescriptions and takes into account only three months of a patient’s prescription history.

Benzodiazepines are responsible for an increasing number of overdose deaths.

In 2012, Tasmania introduced Australia’s first real-time monitoring system – the Drugs and Poisons Information System Online Remote Access (DORA) – a system that automatically screens a patient’s prescribing history without the doctor needing to call the hotline. However, the same episode of Lateline also revealed that the DORA system is not yet mandatory in the state.

The Western Australian and Victorian Governments are expected to roll out the EERCD system next year.

South Australia has given in principle support for the system, but Queensland “has baulked” at the idea of replacing their current system, Nicole MacKee wrote in the Medical Journal of Australia.

A Queensland Health spokesperson was reported as saying that an analysis of the program found that the ERRCD system was costly to implement, did not meet regulatory standards and required significant improvement.

South Australia, the ACT and the Northern Territory have made no firm commitments to an ERRCD system.

Patient Lee* said a GP prescribed two different anti-depressants and Diazepam tablets to treat her severe depression, anxiety and panic disorder.

“They made me feel really good and I started taking a lot more. I then started doctor shopping, seeing two to three additional doctors on a regular basis,” she said.

Lee agreed with the need to crack down on S4 benzo prescribing through real-time monitoring systems.

“One night, after taking a whole lot of Diazepam, I took my child for a drive in the car to get some food and ended up smashing into some shopping trolleys, a stop sign, and my car was a wreck,” Lee said.

She said real-time monitoring “is going to deter a lot of people to even go there (doctor shopping). They’re not going to be able to lie”.